News

Late Wednesday night, the Senate passed a much anticipated third emergency funding bill to help combat the spread of the virus and the negative economic impact its having on the country. The Coronavirus Aid, Relief, and Economic Security (“CARES”) Act:

• Provides $100 billion to hospitals and healthcare providers to ensure they continue to receive the support they need for COVID-19 related expenses and lost revenue;
• creates a “paycheck protection program” that would provide 8 weeks of cash-flow assistance to small employers;
• Gives the Secretary more flexibility to waive additional Medicare telehealth requirements; and
• Temporarily suspends the 2% Medicare sequestration.

The House of Representatives is expected to vote on the bill as soon as tomorrow. MGMA Government Affairs will continue to monitor these legislative developments and provide updates via the COVID-19 Action Center.

Today, the Centers for Medicare & Medicaid Services (CMS) issued guidance on Secretary Azar’s waiver authority that broadens access to Medicare telehealth services. Effective March 6, 2020 and for the duration of the COVID-19 Public Health Emergency, CMS will:

·     Waive geographic restrictions, meaning patients can receive telehealth services in non-rural areas;

·     Waive originating site restrictions, meaning patients can receive telehealth services in their home;

·     Allow use of telephones that have audio and video capabilities; 

·     Allow reimbursement for any telehealth covered code, even if unrelated to COVID-19 diagnosis, screening, or treatment; and

·     Not enforce the established relationship requirement that a patient see a provider within the last three years.

The Medicare telemedicine healthcare provider fact sheet can be found here. The Medicare FAQ on these telehealth waivers can be found here. The Enforcement Discretion for telehealth remote communications during the COVID-19 notice can be found here.

This announcement follows MGMA efforts to encourage CMS to expeditiously expand telehealth coverage in response to the public health emergency. 

Visit the MGMA COVID-19 Action Center for the latest developments impacting medical practices. 

Questions?

Contact MGMA Government Affairs by emailing govaff@mgma.org or calling 202.293.3450, 877.275.6462 toll-free

Due to the spread of COVID-19, President Trump last Friday declared a national emergency, which expands the Administration’s ability to implement regulatory flexibilities through “blanket waivers” of generally applicable Medicare, Medicaid, and CHIP program requirements. When a blanket waiver is issued, it applies broadly and clinicians do not need to apply for individual waiver protection. The Department of Health and Human Services (HHS), together with the Centers for Medicare & Medicaid Services (CMS), has already acted under this authority to implement a number of waivers including:

·     Allowing licensed providers to render services outside their state of enrollment for purposes of billing Medicare and Medicaid. 

·     Temporarily suspending certain enrollment requirements under Medicare, postponing revalidation actions, and expediting pending or new applications.

·     Removing the requirement for a 3-day prior hospitalization prior to coverage of a SNF stay and adding flexibility for obtaining renewed coverage for certain beneficiaries who have recently exhausted SNF benefits.

·     Extending certain timelines for filing Medicare Parts B, C, and D appeals.

These waivers generally have retroactive effect as of March 1. Notably, no waiver around Medicare telehealth coverage and billing has yet been issued. MGMA is closely monitoring this situation and will continue to make updates to our COVID-19 Action Center as they become available. We encourage you to bookmark the COVID-19 Action Center today and check back routinely, as we will be updating it consistently throughout the coming days and weeks.

With physician practices increasingly vulnerable to cyber attacks and other incidents that could lead to patient information being inappropriately revealed, MGMA has developed a new member-exclusive resource to help practice leaders better understand and implement the HIPAA breach requirements. The MGMA HIPAA Breach Toolkit outlines how practices can determine if the disclosure is a reportable breach under the law and what steps the practice must take to inform patients, the federal government, and potentially even local media outlets of the disclosure. In addition, the toolkit discusses the role of business associates in the event of a data breach and offers suggestions on effectively documenting how the breach occurred and the steps practices took following identification of the breach.

In a recent blog post, CMS announced changes to its various public quality performance tools, such as Physician and Hospital Compare. The goal of these tools is to help beneficiaries make informed healthcare decisions, find physicians, and view certain performance data collected from quality reporting programs like MIPS.  

While there are currently eight independent tools, this spring CMS plans to combine and standardize these existing Compare tools. CMS claims this will permit users to access the same information through a single point of entry and simplify navigation to find the information that is currently divided. This new version will be called Medicare Care Compare. 

In the past, CMS has established review and dispute periods to correct preliminary datasets. MGMA encourages members to access Physician Compare to ensure the accuracy of data during such periods and will keep members informed about future review opportunities, as well as any further developments about the new Care Compare website.

Some medical group practices have been told to immediately purchase and use Clinical Decision Support Mechanism (CDSM) software to comply with the Appropriate Use Criteria (AUC) program, with vendors suggesting that claims payment would be impacted in 2020. In a posting on its website, the Centers for Medicare & Medicaid Services (CMS) reiterated that 2020 is an educational and operational testing period and there are no payment consequences this year.

The AUC program will require ordering professionals to consult CDSM software for certain advanced imaging tests and require rendering professionals to include that consultation code on their Medicare claims starting in 2021. Practices are encouraged, however, to plan for implementation of CDSM software and test workflows at some point this year. Access the MGMA AUC Toolkit for additional information on the program.

MGMA joined over 60 other groups to express support for the Social Determinants Accelerator Act (H.R. 4004), which would provide communities assistance in developing innovative, evidence-based approaches to coordinate health and social services while encouraging cross-sector coordination. The letter also asks the U.S. House of Representatives Energy & Commerce Committee to hold a hearing to discuss H.R. 4004, including the challenges and opportunities in addressing social determinants of health at large.

The deadline to apply for the Primary Care First (PCF) Model and Kidney Care Choices (KCC) Model is fast approaching. PCF will build off the existing CPC+ Model and be offered in 26 geographic regions, while KCC will expand upon the existing Comprehensive ESRD Care Model through four payment options. Practices selected for each program will begin implementation in the latter half of 2020. If your practice is interested in applying for either of these programs, you can do so through the online PCF or KCC application portal. Each model will become an advanced alternative payment model starting in CY 2021.

Physicians are encouraged to review open payments data for program year 2018 that has been submitted from healthcare entities including drug and device manufacturers. Review of this information is voluntary, but incorrect data can only be disputed during the year it is published. For more information visit the CMS Open Payments website.

Starting Jan. 1, Medicare will only accept the Medicare Beneficiary Identifier (MBI) on claims. CMS has indicated that 86% of Medicare claims currently contain the MBI. If patients do not present with their new Medicare card, you can access the MBI through your Medicare Administrative Contractor web portal. Download the member-benefit New Medicare Card Toolkit for additional information.